title: FDG-PET-CT and whole-body MRI for triage in patients planned for radioembolisation therapy.
abstract: OBJECTIVE
  The purpose was to evaluate the potential of FDG-PET-CT and whole-body MRI (WB-MRI) as diagnostic triage methods for patients planned for radioembolisation of metastatic liver disease.
  
  
  METHODS
  135 patients with multifocal liver metastases were evaluated for potential palliative therapy with radioembolisation using 90-Yttrium microspheres. All patients were examined consecutively with FDG-PET-CT and WB-MRI for exclusion of relevant extra-hepatic tumor manifestations. All patients underwent 99mTc-albumine angiography followed by scintigraphy to exclude significant hepato-pulmonary shunting.
  
  
  RESULTS
  Out of the 135 patients included into the pre-therapeutic diagnostic algorithm, 56% were eligible and received radioembolisation, while 44% could not be treated. In 91% the exclusion criteria was diagnosis of significant extra-hepatic metastatic disease. In 85% exclusion diagnosis was made concordantly by both FDG-PET-CT and WB-MRI, in 9% diagnosis was provided by PET-CT, in 6% by WB-MRI alone. Patient-based sensitivity for detection of extra-hepatic disease was 94% for PET-CT and 91% for WB-MRI. False-positive diagnosis of extrahepatic disease leading to exclusion for radioembolisation therapy was made in 2% of patients, in one patient by PET-CT and in one patient by WB-MRI alone. Overall, specificity for inclusion of radioembolisation therapy by combining both modalities was 99%. In 9% of patients angiographic diagnosis made radioembolisation impossible, in 7% solely the angiographic findings were decisive.
  
  
  CONCLUSIONS
  Both FDG-PET-CT and WB-MRI are efficient diagnostic triage methods for patients planned for radioembolisation of liver metastases. Overall, FDG-PET-CT shows a trend to higher diagnostic accuracy compared to WB-MRI and may be used as imaging method of choice as a standalone examination. In combination, both modalities exhibited high sensitivity for the diagnosis of extra-hepatic tumor manifestations and result in high specificity.
authors.affiliation: Department of Clinical Radiology, University Hospitals Munich-Grosshadern, LMU, Marchioninistr. 15, 81377 München, Germany. gerwin.schmidt@med.uni-muenchen.de
authors.forename: G P
authors.initials: GP
authors.lastname: Schmidt
authors.forename: P
authors.initials: P
authors.lastname: Paprottka
authors.forename: T F
authors.initials: TF
authors.lastname: Jakobs
authors.forename: R T
authors.initials: RT
authors.lastname: Hoffmann
authors.forename: A
authors.initials: A
authors.lastname: Baur-Melnyk
authors.forename: A
authors.initials: A
authors.lastname: Haug
authors.forename: M
authors.initials: M
authors.lastname: Notohamiprodjo
authors.forename: A
authors.initials: A
authors.lastname: Baur-Melnyk
authors.forename: K
authors.initials: K
authors.lastname: Nikolaou
authors.forename: M F
authors.initials: MF
authors.lastname: Reiser
authors.forename: C
authors.initials: C
authors.lastname: Rist
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000792:Angiography / Q000379:methods; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007472:Iohexol / Q000031:analogs & derivatives; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D012984:Software; D013668:Technetium Tc 99m Aggregated Albumin; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014218:Triage / Q000379:methods*; D051598:Whole Body Imaging; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes; D019788:Fluorodeoxyglucose F18; D007472:Iohexol; C038192:iopromide; D019786:Gadolinium DTPA